Tobacco and end stage renal disease: a multicenter, cross-sectional study in Argentinian Northern Patagonia
More details
Hide details
Northern Patagonia Association of Nephrology, Neuquén, Argentina
Unidad Renal Cipolletti, Río Negro, Argentina
Department of Economy and Statistics of INTA (National Institute of Agrological Technology) Estación Experimental Alto Valle del Río Negro, Río Negro, Argentina
Submission date: 2014-08-23
Acceptance date: 2015-08-20
Publication date: 2015-09-01
Corresponding author
Maria M. Alba   

Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén 8300, Argentina
Tobacco Induced Diseases 2015;13(September):28
Smoking and chronic kidney disease are major public health problems with common features -high prevalence and mortality, high cardiovascular risk, gender differences and high prevalence in low income people-, but the link between them is poorly recognized. Our objectives were to investigate the exposure of dialysis patients to tobacco and to know their smoking behavior.

We performed a multicenter, cross-sectional study in nine dialysis units in the Argentinian Northern Patagonia. We investigated smoker status, lifetime tobacco consumption, current tobacco use, breath carbon monoxide and % carboxyhaemoglobin. Fagerström and Richmond tests were performed for active smokers. Statistical analysis: one way ANOVA and Tukey’s test for post hoc test. For exploratory analysis, frequency tables through chi-square distribution and single correspondence analysis were performed.

Six hundred thirty six patients (60.9 % males, 39.1 % females) were interviewed. Almost 70 % of them had had tobacco exposure. Excluding light smokers, the lifetime consumption was significantly different (p = 0.0052) between sexes (33.1 ± 2.4 pack/years in males and 18.2 ± 2.1 pack/years in females) The distribution of etiologies changed significantly (χ 2 p < 0.0001) with smoker status and the dose of tobacco smoking, with an increase in the diagnosis of nephrosclerosis in patients with high and very high lifetime consumption (from 16.1 % in non-smokers to 28.2 and 27 % respectively), and in passive smokers (from 16.1 to 27.3 %). The male preponderance of end-stage renal disease disappeared when only non-smokers were considered and grew with the increase in the lifetime consumption. Active smokers have small consumption, both low CO level and % COHb, low dependence and a good motivation to quit, but a high lifetime consumption.

Exposure of dialysis patients to tobacco is high and could be related to the progression to the final stage of the renal disease. It seems that tobacco renal damage is mostly hidden in the diagnosis of nephrosclerosis. The gender difference observed in these patients could also have a nexus with the men’s higher tobacco exposure. Active smokers have a low current consumption but a high lifetime tobacco dose.

Couser W, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80(12):1258–70. doi:10.1038/ki.2011.368.
Stack A, Bloembergen W. Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: a cross-sectional study. J Am Soc Nephrol. 2001;12:1516–23.
Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence of absence? Clin J Am Soc Nephrol. 2008;3(1):226–36. doi:10.2215/CJN.03740907.
Schrier R. Smoking: the most preventable disease. Nat Clin Pract Nephrol. 2007;3(7):351.
Stack A, Murthy B. Cigarette use and cardiovascular risk in chronic kidney disease: an unappreciated modifiable lifestyle risk factor. Semin Dial. 2010;23(3):298–305.
Eriksen M, Mackay J, Ross H. The tobacco Atlas (4th ed): American Cancer Society and World lung Foundation. 2012.
US Renal data System UADR. Atlas of Chronic Kidney Disease and End-Stage Renal disease in the United States National Institutes of Health, National Institute of Diabetes and Digestive and Kidney disease; Bethesda MD.
Carter BD, Abnet CC, Feskanich D, Freedman ND, Hartge P, Lewis CE, et al. Smoking and mortality--beyond established causes. N Engl J Med. 2015;372(7):631–40.
Rhee CM, Kovesdy CP. Epidemiology: Spotlight on CKD deaths-increasing mortality worldwide. Nat Rev Nephrol. 2015;11(4):199–200. doi:10.1038/nrneph.2015.25.
White WB. Smoking-related morbidity and mortality in the cardiovascular setting. Prev Cardiol. 2007;10(2 Suppl 1):1–4.
Shlipak M, Fried L, Cushman M, Manolio T, Peterson D, Stehman-Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA. 2005;293(14):1737–45.
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. Jama. 2014;311(2):183–92. doi:10.1001/jama.2013.284692.
Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int. 2006;69(2):375–82. doi:10.1038/
Mackenbach J, Stirbu I, Roskam A, Schaap M, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468–81.
Garcia-Garcia G, Jha V, Committee. WKDS. CKD in disadvantaged populations. Kidney Int. 2015;87(2):251–3.
Obrador GT, Pereira BJ, Kausz AT. Chronic kidney disease in the United States: an underrecognized problem. Semin Nephrol. 2002;22(6):441–8.
Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking and physical inactivity as risk factors for CKD: Are men more vulnerable? Am J Kidney Dis. 2006;47(3):396–405.
Gurland HJ, Brunner FP, von Dehn H, Härlen H, Parsons FM, Schärer K. Combined report on regular dialysis and transplantation in Europe. Proc Europ Dialysis Transplant Assoc. 1973;10:17–57.
Marinovich S, Lavorato C, Bisigniano L, Soratti C, Hansen Krogh D, Celia E et al. Registro argentino de Diálisis Crónica 2011- Informe 2012 (Parte I). Nefrología Argentina. 2013;11(2).
Jager KJ, van Dijk PCW, Dekker FW, Stengel B, Simpson K, Briggs JD. The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes. Clin Nephrol. 2003;60(5):352–60.
Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, et al. Predictors of early mortality among incident US Hemodialysis patients in the dialysis outcomes and practise patterns study (DOPPS). Cl J Am Soc Nephrol. 2007;2(1):89–99.
Di Rienzo JA, Casanoves F, Balzarini MG, Gonzalez L, Tablada M, Robledo CW. Software estadístico. InfoStat versión 2013. Grupo InfoStat, FCA, Universidad Nacional de Córdoba, Argentina. 2013.
INDEC. Censo Nacional de Población, Hogares y Viviendas 2010. Argentina: Censo del Bicentenario; 2012.
Burn JH, Truelove LH, Burn I. The antidiuretic action of nicotine and of smoke. Br Med J. 1945;1:403–6.
Christiansen JS. Cigarette smoking and prevalence of microangiopathy in juvenile-onset insulin-dependent diabetes mellitus. Diabetes Care. 1978;1(3):146–9.
Dales LG, Friedman GD, Siegelaub AB, Seltzer CC, Ury HK. Cigarette smoking habits and urine characteristics: urinalysis abnormalities are more common is smokers, but the reasons are unclear. Nephron. 1978;20(3):167–70.
Orth SR, Ritz E, Schrier RW. The renal risks of smoking. Kidney Int. 1997;51(6):1669–77.
Aird WC. Phenotypic heterogeneity of the endothelium: II. Representative vascular beds. Circ Res. 2007;100(2):174–90. doi:10.1161/
Banas MC, Banas B, Wolf J, Hoffmann U, Krüger B, Böger CA, et al. Smoking behaviour of patients before and after renal transplantation. Nephrol Dial Transplant. 2008;23(4):1442–6.
Pascual Lledó JF. Epidemiología del tabaquismo y morbimortalidad asociada con el consumo de tabaco en el mundo. In: Jiménez Ruiz CA FK, editor. Tratado de tabaquismo. Sweden: Aula Médica; 2011. p. 33–54.
Clemente Jiménez ML, Pau Pubil M, Pérez Trullén A, Trenc Español P, Rubio AE. Tabaquismo pasivo. In: Jiménez-Ruiz C, Fagerström K, editors. Tratado de tabaquismo. Madrid: Aula médica; 2011. p. 261–76.
Prugger CWJ, Heidrich J, De Bacquer D, Perier MC, Empana JP, Reiner Ž, et al. Passive smoking and smoking cessation among patients with coronary heart disease across Europe: results from the EUROASPIRE III survey. Eur Heart J. 2014;35(9):590–8.
Ejerblad E, Fored CM, Lindblad P, Fryzek J, Dickman PW, Elinder CG, et al. Association between smoking and chronic renal failure in a nationwide population-based case–control study. J Am Soc Nephrol. 2004;15:2178–85.
He J, Vupputuri S, Allen K, M.R. P, Hughes J, Whelton PK. Passive smoking and the risk of coronary heart disease. A metaanalysis of the epidemiologic studies. N Engl J Med. 1999;25(340):920–6.
Howard G, Burke GL, Szklo M, Tell GS, Eckfeldt J, Evans G, et al. Active and passive smoking are associated with increased carotid wall thickness. The Atherosclerosis Risk in Communities Study. Arch Intern Med. 1994;154(11):1277–82.
Lhotta K, Rumpelt HJ, Konig P, Mayer G, Kronenberg F. Cigarette smoking and vascular pathology in renal biopsies. Kidney Int. 2002;61(2):648–54. doi:10.1046/j.1523-1755.2002.00171.x.
Odoni G, Ogata H, Viedt C, Amann K, Ritz E, Orth SR. Cigarette smoke condensate aggravates renal injury in the renal ablation model. Kidney Int. 2002;61(6):2090–8. doi:10.1046/j.1523-1755.2002.00382.x.
Egleton RD, Brown KC, Dasgupta P. Angiogenic activity of nicotinic acetylcholine receptors: implications in tobacco-related vascular diseases. Pharmacol Ther. 2009;121(2):205–23. doi:10.1016/j.pharmthera.2008.10.007.
Silbiger SR, Neugarten J. The impact of gender on the progression of chronic renal disease. Am J Kidney Dis. 1995;25(4):515–33.
Silbiger S, Neugarten J. Gender and human chronic renal disease. Gend Med. 2008;5 Suppl A(Suppl A):S3–10. doi:10.1016/j.genm.2008.03.002.
Bak S, Sindrup SH, Alslev T, Kristensen O, Christensen K, Gaist D. Cessation of smoking after first-ever stroke: a follow-up study. Stroke. 2002;33(9):2263–9.
Orth SR. Cigarette smoking: an important renal risk factor - far beyond carcinogenesis. Tob Induc Dis. 2002;1(2):137–55. doi:10.1186/1617-9625-1-2-137.
Wetzig GA, Gough IR, Furnival CM. One hundred cases of arteriovenous fistula for haemodialysis access: the effect of cigarette smoking on patency. Aust N Z J Surg. 1985;55(6):551–4.
Foley RN, Herzog CA, Collins AJ. Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 study. Kidney Int. 2003;63(4):1462–7. doi:10.1046/j.1523-1755.2003.00860.x.
Sung RS, Althoen M, Howell TA, Ojo AO, Merion RM. Excess risk of renal allograft loss associated with cigarette smoking. Transplantation. 2001;71(12):1752–7.
Richmond R. Teaching medical students about tobacco. Thorax. 1999;54(1):70–8.
Prochaska J, Di Clemente C. Treating addictive behaviors: process of change. New York: Plenum Press; 1986.
Ramos Pinedo A, Prieto GE. Estudio clínico del fumador. In: Jiménez-Ruiz CA, Fagerström KO, editors. Tratado de tabaquismo. Madrid: Aula médica; 2011. p. 295–308.
Fagerstrom KO, Schneider NG. Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. J Behav Med. 1989;12(2):159–82.
Pérez Trullén A, Lázaro Sierra J, Clemente Jiménez M, Herrero Labarga I, Pau Pubil M, Cascán HM. Marcadores biológicos y funcionales de susceptibilidad, exposición y lesión por el consumo de tabaco. In: Jiménez-Ruiz CA, Fagerström KO, editors. Tratado de tabaquismo. Madrid: Aula Médica; 2011. p. 323–40.
Clark KD, Wardrobe-Wong N, Elliott JJ, Gill PT, Tait NP, Snashall PD. Cigarette smoke inhalation and lung damage in smokers volunteers. Eur Respir J. 1998;12(2):395–9.
Janzon L, Lindell SE, Trell E, Larme P. Smoking habits and carboxyhaemoglobin: a cross-sectional study of an urban population of middleaged men. J Epidemiol Community Health. 1981;35:271–3.
Jiménez-Ruiz CA, Masa F, Miravitlles M, Gabriel R, Viejo J, Villasante C, et al. Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest. 2001;119(5):1365–70.
Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece
Marios Spanakis, Marianna Roubedaki, Ioannis Tzanakis, Michail Zografakis-Sfakianakis, Evridiki Patelarou, Athina Patelarou
International Journal of Environmental Research and Public Health
End-stage kidney disease in patients with clinically manifest vascular disease; incidence and risk factors: results from the UCC-SMART cohort study
Helena Østergaard, Jan Westerink, Marianne Verhaar, Michiel Bots, Folkert Asselbergs, Borst de, L. Kappelle, Frank Visseren, der van
Journal of Nephrology
Journals System - logo
Scroll to top